Health: Crude Concept and Philosophical Question
Who among us did not speak of what is healthy and what is harmful before the arrival of Hippocrates?” This is how Epictetus, in his lectures, explains and dissolves the popular belief in the existence of an a priori notion of health and the healthy — whose relation to objects and behaviors is said, moreover, to be uncertain.1 Still, if we admit that such a definition of health is indeed possible without reference to some explicit knowledge, where would we seek its foundation?
It would be inappropriate, here in Strasbourg,2 to subject to your examination some reflections on health without pointing out the definition suggested a half century ago by a famous surgeon and professor at the Faculty of Medicine from 1925 to 1940: “Health is life lived in the silence of the organs.”3 It was perhaps thanks to conversations between colleagues at the Collège de France that Paul Valéry came to echo René Leriche in writing that “health is the state in which necessary functions are achieved imperceptibly or with pleasure.”4 Earlier, Charles Daremberg, in his collection of articles La médecine, histoire et doctrines (1865), had written that “in health one does not feel the movements of life; all functions are accomplished in silence.”5 And after Leriche and Valéry, the likening of health to silence was made by Henri Michaux but was deemed negative: “Just as the body (its organs and its functions) has been mainly known and revealed not by the prowess of the strong, but by the disorders of patients, of the weak, of the infirm, and of the wounded (health being quiet and the source of this immensely erroneous impression that goes all by itself [de soi]), it is the disturbances of the spirit, its dysfunctions, that will be my teachers.”6 Well before all these, and perhaps more subtly than any of them, Diderot wrote in his Lettre sur les sourds et muets à l’usage de ceux qui entendent et qui parlent (1751): “When we go well, no part of the body informs us of its existence; if by some pain it informs us of itself, it is then certain that we are not doing well; and even if by pleasure, it is not always certain that we are doing better.”7
Health was a frequent philosophical topic during the classical period and the Enlightenment, approached almost always in the same way — by reference to disease, whose absence was generally held to be the equivalent of health. For example, Leibniz, while discussing Pierre Bayle’s theses on good and evil in Theodicy (1710), wrote: “But does physical good lie solely in pleasure? M. Bayle appears to be of this opinion; but I consider that it lies also in a middle state, such as that of health. One is well enough when one has no ill; it is a degree of wisdom to have no folly” (sec. 251). Leibniz adds: “M. Bayle would wish almost to set aside the consideration of health; he likens it to the rarefied bodies, which are scarcely felt, like air, for example; he likens pain to the bodies that have much density and much weight in slight volume. But pain itself makes us aware of the importance of health when we are bereft of it” (sec. 259).8
Among the philosophers who paid the most attention to the question of health, it is necessary to point out Kant. Strengthened by the successes and failures of his private art of living (of which, in 1804, Andreas Christoph Wasianski wrote a long account),9 Kant addressed the question of health in the third section of The Conflict of the Faculties (1798). As for health, he says, we find ourselves in embarrassing conditions: “He can feel well (to judge by his comfortable feelings of vitality), but he can never know that he is healthy. . . . Hence if he does not feel ill, he is entitled to express his well-being only by saying that he is apparently in good health.”10 These remarks by Kant are important, in spite of their apparent simplicity, because they make health an object outside the field of knowledge. Let us bolster the Kantian statement: there is no science of health. Let us accept this for the moment. Health is not a scientific concept; it is a crude concept. Which is not to say that it is trivial or out of reach, but simply rough and inexact.
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Notes
This translation is based on “La santé, concept vulgaire et question philosophique,” chap. 3 of Écrits sur la médecine (Paris: Seuil, 2000); the essay originally appeared as “La santé” in Cahiers du séminaire de philosophie 8 (1988): 119 – 33. We thank Éditions Sables, the publisher of Cahiers, for allowing us to reproduce the essay in translation. — Trans.
- Epictetus, Dissertationes ab Arriano digestae, 2.17.8.
- The essay was originally given as a lecture in Strasbourg, France, in May 1988. — Trans.
- See also Canguilhem’s discussions of Leriche in The Normal and the Pathological, trans. Carolyn Fawcett (New York: Zone, 1989), and in Knowledge of Life, ed. Paola Marrati and Todd Meyers, trans. Stefanos Geroulanos and Daniela Ginsburg (New York: Fordham University Press, forthcoming). — Trans.
- Paul Valéry, Mauvaises pensées et autres (Paris: Gallimard, 1942).
- Charles Daremberg, La médecine, histoire et doctrines (Paris: Didier, 1865).
- Henri Michaux, Les grandes épreuves de l’esprit et les innombrables petits (Paris: Gallimard, 1966), 14.
- Denis Diderot, Lettre sur les aveugles; Lettre sur les sourds et muets (Paris: Flammarion, 2000), 110.
- G. W. Leibniz, Theodicy, trans. E. M. Huggard (Indianapolis, Ind.: Bobbs-Merrill, 1966), 281, 285 – 86.
- Andreas Christoph Wasianski, Immanuel Kant, sein Leben in Darstellungen von Zeitgenossen (Berlin: Deutsche Bibliothek, 1912).
- Immanuel Kant, The Conflict of the Faculties, trans. Mary J. Gregor (New York: Abaris, 1979), 181.